HomeMy WebLinkAboutHoman OFFICE OF THE TOWN CLERK cOFVtir
Town of Southold ,£ ��G
Judith T. Terry, Town Clerk ,
Town Hall, 53095 Main Road c c a 4 r
'
P. O. Box 1179 �,
Southold, New York 11971 05, ®
4
Telephone ®.j
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 478 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Homan Realty Inc.
OWNER MAILING ADDRESS: 666 Warren Street
Baldwin, New York 11510
OWNER PROPERTY ADDRESS: Main Road
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-223-7422
TAX MAP NO. : Section 141 Block 4 Lot 40
CROSS STREET: Pacific Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
!.. iC� th e y
Southold Town Clerk
DATE: November 4, 1987
' (TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold �OtCQ ' Application No. 4/ 7,C"--/
Judith T. Terry, Town Clerk �,
Town Hall, 53095 Main Road ?rY :G i Residential
. :
P. O. Box 1179 cr3 W ' .' Non-Residential
Southold, New York 11971 O � '_ �•`�
Telephone ®.( y Y►� �•
(516) . 765-1801
TOWN OF SOUTHOLD
RECEIVED SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OCT 2 61987
APPLICATION
Town Clerk Southold
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE / 0•
OWNER NAME: /-Iam614,, ( I-1.
OWNER MAILING ADDRESS: .“ �a-�r��n.Sd-rte•
Rik I 0.( s/
OWNER PROPERTY ADDRESS: 0"la.tin ienaA
l4ot+1-Iiru:k
OWNER TELEPHONE NUMBER:
y TAX MAP NO. : Section 19/ Block I/ Lot 90
CROSS STREET: Palet"� S7v-ee-/—
TYPE OF SYSTEM: Septic Tank New Existing /
Cesspool New Existing v
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest _road.)
04)
Signature jApplicant
RECEIVED BY:
Town Clerk's Office
DATE:
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